Healthcare Provider Details

I. General information

NPI: 1437696663
Provider Name (Legal Business Name): EDWARD MARCHESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE LURIE CHILDREN'S HOSPITAL
CHICAGO IL
60611
US

IV. Provider business mailing address

225 E CHICAGO AVE #152 LURIE CHILDREN'S HOSPITAL
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-0078
  • Fax:
Mailing address:
  • Phone: 312-227-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.070164
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.152741
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: